EBM in action: Is laser treatment effective and safe for musculoskeletal pain?

In reply: Chow criticises us for not identifying all relevant trials. But is she willing to help others in the process of reviewing? We could not identify a systematic review of the area with her involvement, nor does she appear to have registered an appropriate protocol with the Cochrane Collaboration (instructions for which are available at <http://www.cochrane.de>). Systematic reviews are important to help clinicians make sense of a diversity of trials. If experts such as she, devoting years to the area, do not help us, who should?

We were not attempting such a systematic review (which would probably take several months of work). Rather, we were trying to provide clinicians with the best obtainable answer in a 24–48-hour turnaround time.2 Given that clinicians might have one question per patient,1 attempting a systematic review with each question would give us a lifetime of work after only a fortnight of clinical work! We needed to balance the timely requirements of clinicians with the quality of the evidence obtained. As Chow points out, tracking down every last trial is difficult. Therefore, we first aimed to identify systematic reviews rather than attempting to find all trials ourselves. These reviews missed some relevant material — as indeed did Chow, who did not cite several recent studies,3,4 which makes us wonder if she has a strong prior belief that may bias her views. Would these missed trials have made any difference to the conclusions we reached previously? A systematic review published since our original literature report (January 2000) suggests not, although there may be some specific subgroups of patients and conditions for which laser therapy is effective.5

All of this highlights the need for a collective effort to sort out the mess of medical information. In seven years the Cochrane Collaboration has systematically reviewed less than 5% of more than 300 000 trials on the clinical trials registry. They are difficult to perform and maintain. Millions of dollars continue to pour into primary research that still remains inaccessible to us at the clinical frontline, the "great criticism" with which Archie Cochrane pricked the profession into action.6 Please, Dr Chow, abandon throwing bricks from the sidelines, and join us in trying to help clinicians access research evidence in the timely fashion needed for day-to-day practice!